pre op assessment Flashcards
When is the pre-assessment clinic before surgery?
It is two weeks before admission and usually FY1 lead
Which types of examinations are carried out in the pre-assessment clinic?
Cardiovascular examinations respiratory examinations
and examinations of the relevant system
What is ASA status?
It is how anaesthetists grade comorbidity
1= normal healthy individuals
2= mild systemic disease that does not limit activity
3= severe disease that is not incapacitating
4= severe disease that is a threat to life
5= moribund patient, not expected to survive 24hrs
What is the risk of having a pre-operative MI if you have already had one?
10-20% if MI <3/12 ago
1-2% if MI >6/12 ago
But long before surgery should a monoamine oxidase inhibitor be stopped?
Two weeks
Because it can cause hypertension with Anaesthesia
How long before surgery should an SSRI be stopped?
Three weeks
How long before surgery should an oral contraceptive be stopped?
Four weeks
How long before surgery should aspirin be stopped?
Seven days
How long before surgery should clopidogrel be stopped?
Five days
How long before surgery should warfarin be stopped?
Five days
And should you do a pre-operative ECG?
- For men over 40 and women over 50
- they are undergoing high risk surgery
- if they have more than one risk factor for coronary heart disease.
what blood tests should be done pre-operatively?
- full blood count
- urea and electrolytes
- coagulation screen
- glucose
- liver function tests in biliary / colorectal surgery
- calcium in thyroid surgery
- group and save / crossmatch
- TSH if hypo or hyperthyroid disease
what can be used to assess heart failure in pre-operative patients?
assess severity (NHYA class) I- no limitation II- ordinary activity leads to dyspnoea III- little activity leads to dyspnoea IV- dyspnoea at rest
echocardiogram
what are you unable to use in a patient with a pacemaker?
a medical and surgical technique involving the production of heat in a part of the body by high-frequency electric currents, to stimulate the circulation, relieve pain, destroy unhealthy tissue, or cause bleeding vessels to clot.
what should you give as a replacement for warfarin preoperatively?
- LMW heparin
what is the risk of smoking preoperatively?
- 6x increased respiratory complications
- carbon monoxide levels can be ~ 5%
- reduces Hb O2 carrying capacity
- inhibits O2 release
- nicotine increases cardiac demand
improves after 24-48 hours abstinence - respiratory function takes 6/52 to improve
what should blood pressure be before elective surgery?
<160 mmHg systolic
<100 mmHg diastolic
how can respiratory function be assessed ore-operatively?
- peak flow
- FEV1/FVC (>70%)
- should be able to walk for 6 mins
when is a CXR done preoperatively?
- acute respiratory symptoms
cardio-respiratory disease and no CXR within 1 year - recent immigrant from a country where TB is endemic
undergoing cardiopulmonary - bypass
- possible pulmonary metastases
what should you consider pre-operatively for a patient who is on steroids?
- you should establish how much steroids they’ve been taking and for how long, because they may not be able to make their own due to adrenal suppression associated with long term steroid use
- endogenous corticosteroids are important for the stress response and if there aren’t enough you can have addisonisan crisis- when you have inadequate glucose
- IV hydrocortisone should be given to combat this
what type of DVT prophylaxis can you give?
all patients to have prophylaxis LMWH unfractionated heparin if renal dysfunction TEDS unless a vascular patient usually stop OCP 4/52 prior
what should be a consideration of a risk for people with rheumatoid arthritis?
- should do a cervical x-ray as risk of…
Atlanto-axial subluxationis a disorder of C1-C2 causing impairment in rotation of the neck.
The anterior facet of C1 is fixed on the facet of C2.
what are preoperative measures that can be taken for people with respiratory disease?
saline nebulisers
brochodilators
chest physiotherapy
What should be a consideration for alcoholics?
They are at increased risk of infection and also they are at risk of alcohol withdrawal so you can give them chlordiazepoxide which is a benzo which can help with their withdrawal symptoms.
What is a consideration for people with sickle-cell?
They can undergo sickle-cell crisis when they have general Anaesthesia
What should be a consideration for opioid addict?
They may have an increased tolerance to opioids so you may need to give them more opioids you must also watch out for withdrawals after the surgery
But should be considered for chronic renal failure patients?
- Uraemia in pairs platelet function but the effect can be reversed using desmopressin
- clearance of narcotics is poor and post operative narcosis can be seen
you can give an naloxone for this which can be given as a bonus and followed up by IV infusion. - do not use fistulas to cannulate and do not use the cephalic vein as this may be another place for a fistula.
- central lines should be put in jugular veins rather than subclavian vein’s since subclavian vein stenosis could prevent satisfactory fistula function
what ASA grade are you automatically if you smoke?
2
what are the stages of a surgical procedure according to WHO?
- Sign in - before induction
- Time out - before the first incision
- Sign out - after last incision and before patient leaves the operating room
what id the WHO surgical check list?
- Patient has confirmed: Site, identity, procedure, consent
- Site is marked
- Anaesthesia safety check completed
- Pulse oximeter is on patient and functioning
- Does the patient have a known allergy?
- Is there a difficult airway/aspiration risk?
- Is there a risk of > 500ml blood loss (7ml/kg in children)?
what is the checklist before a surgical procedure?
- Patient has confirmed: Site, identity, procedure, consent
- Site is marked
- Anaesthesia safety check completed
- Pulse oximeter is on patient and functioning
- Does the patient have a known allergy?
- Is there a difficult airway/aspiration risk?
- Is there a risk of > 500ml blood loss (7ml/kg in children)?
what is the rule on food and drink before surgery?
drink clear fluids up to 2 hours before elective surgery and should consume no solid food for 6 hours before elective surgery
